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Breast Feeding Support and Counseling

Last Modified: 5/16/2013 1:49:43 PM

Article: KB00232

The Affordable Care Act (ACA) includes guidelines for coverage of breast feeding support and counseling. Effective July 1, 2012, if you’re covered by a non-grandfathered HMSA plan that has implemented the ACA provisions, you now have 100 percent coverage for breast feeding support and counseling by a trained, participating physician or midwife during pregnancy and/or after giving birth (postpartum). This provision also includes the purchase of a breast pump, limited to one per pregnancy from an HMSA participating provider or medical pharmacy. The breast pump is covered at no charge (no copayment, deductible, or coinsurance).

To find out if your plan has implemented the ACA breast pump provisions, please check your Guide to Benefits and search for breast pump.

Obtaining a breast pump

All available brands and models will be covered as long as the breast pump is obtained from one of the HMSA participating providers or medical pharmacies (when purchased at the pharmacy).

You may get the breast pump before or after giving birth. The breast pump can be manual or electric and doesn’t require a prescription from a physician to be covered.

The rental of a hospital-grade breast pump is covered under non-grandfathered and grandfathered plans if prescribed by a physician for a mother whose baby is unable to be breastfed directly because of a medical condition or because the infant is hospitalized.

Mothers who rent a hospital-grade breast pump will be allowed to obtain a breast pump for the same pregnancy after returning the rental. The benefit allows mothers one purchase per pregnancy.

Noncovered services

HMSA won’t cover replacement breast pumps. If you aren’t happy with the first breast pump obtained with your HMSA plan, purchase of a replacement won’t be covered. It’s best to research and find the breast pump you’d like to use before obtaining one from a participating provider or medical pharmacy.

If you obtain your breast pump at a participating store, please make sure to purchase it at the pharmacy counter. HMSA doesn’t cover the cost of supplies that don’t come with the breast pump or supplies to replace old supplies that came with the pump. Disposable supplies such as replacement milk storage bags, ties, breast shields, batteries, etc., are also not covered.